South Infirmary Victoria University Hospital
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Research by staff affiliated to South Infirmary-Victoria University Hospital
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Increasing melanoma awareness among health and social care professionals in secondary care in an era of reduced skin cancer referrals due to COVID-19.The role of secondary care providers in detecting melanoma has been poorly explored. Our recent study identified that patients with thick melanomas were seen in secondary care in the year prior to their melanoma diagnosis. In this era of reduced skin cancer referrals and heightened public anxiety, it is more important than ever that health professionals are equipped with the knowledge to identify atypical skin lesions to facilitate earlier detection and treatment. The aim of this study was to evaluate the level of awareness of skin cancer among health and social care professionals in secondary care and to facilitate education sessions on skin cancer awareness.
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Bare necessities? The utility of full skin examination in the COVID-19 era.Full skin examination (FSE) may improve the detection of malignant melanoma (MM). The objective of this study was to assess the safety of targeted lesion examination (TLE) compared with FSE in our Pigmented Lesion Clinic (PLC). Patients attending the PLC were randomized in a 2 : 1 ratio to FSE (intervention) or TLE (standard care). Demographic details and risk factors were documented, and the time taken to perform FSE and TLE was noted. Of 763 participants, 520 were assigned to FSE and 243 were assigned to TLE. On average, FSE took 4.02 min and TLE took 30 s to perform. Of the 520 participants assigned to FSE, 37 (7.1%) had incidental findings, of whom 12 patients (2.3%) had additional lesions biopsied. No additional melanomas were detected that would have been missed by use of the standard protocol. This study suggests that in low-risk patients referred to a PLC with a lesion of concern, the possibility of missing incidental cutaneous malignancies using lesion-directed examination is low.
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Distance as a Barrier to Melanoma CareOur aim was to review cases of melanoma diagnosed histologically in UHK in 2016 and to compare them to cases of melanoma nationally and in Kerry. Methods For each patient we recorded age, Breslow depth, and shortest distance to travel by car and travelling time (without traffic) to the South Infirmary Victoria University Hospital (SIVUH) from their primary residence (calculated using Google maps™ (2018)). Results 20 cases of invasive melanoma were diagnosed in UHK in 2016. Of the 20 cases, 9 (45%) presented at a very advanced stage with a Breslow depth of greater than 4mm. A further 7 (35%) cases had a depth of 1.5-4mm. These patients with invasive melanoma had a mean age of 72.5 (±15). The mean shortest distance to travel from the patient’s primary residence to the SIVUH was 114.8km (±15.5) taking an average of 102 minutes (±14.6) by car. Conclusion Cases of melanoma diagnosed locally in UHK presented at an advanced stage compared to the national average. We suspect that the long distances to travel to the SIVUH pigmented lesion clinic is a barrier for these patients.
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Skin Cancer Awareness Amongst Irish GolfersThe aim of this study was to assess skin cancer awareness and identify the UV protective measures used by golfers within the Munster region of Ireland.
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Critical Airway Compromise due to a Massive Vagal SchwannomaWe describe the case of a 37-year-old man with a slowly enlarging neck lump and compressive symptoms. He presented to a separate institution 10 years prior where an observational approach was advocated. Following preoperative investigations and embolization, an 11cm vagal schwannoma was excised and vagus nerve was sacrificed. Although conservative management is appropriate for a select patient population, surgical excision is treatment of choice for cervical neurogenic tumours and paraganglionomas and must be considered in young patients or rapidly expanding tumours to avoid compressive symptoms, as in this case.
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Changing paradigms for oropharynx cancer: swinging of pendulum back towards surgeryThe oropharynx, extending from the soft palate to the level of the epiglottis, and containing the palatine tonsils and base of tongue (BOT), is a common site for Head and Neck cancer. Squamous cell carcinoma (SCC) comprises the overwhelming majority of cases. Traditional aetiological factors for oropharynx SCC (OPSCC) are smoking and alcohol consumption. In recent years, human papilloma virus (HPV) type 16 has emerged as the major cause of an ever increasing number of cases 1 . Over the last two decades, there has been a dramatic surge in the incidence of OPSCC. Figures obtained by the Irish National Cancer Registry show an increase from 50 cases per year in 1994 to over 100 cases per year in 2012. This recent rise in OPSCC incidence is almost exclusively related to an increase in HPV related cancers. In the United States, between 1988 and 2004, HPV related OPSCC showed a 225% increase, while HPV-negative OP SCC showed a 50% decline, attributed to decreased prevalence of smoking 1 .
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The prevalence and genotype of human papillomavirus on cervical samples from an Irish female population with external genital warts.The aim of this study was to determine the cervical genotype profile of females who presented to an STI Clinic with external genital warts (EGW); and to determine the potential vaccine coverage prior to the uptake of the HPV vaccines. Sixty-one cervical scrapings were taken from females aged 18-35 y who had external genital warts or a history of external genital warts. The resulting 50 samples that were positive for HPV-DNA were subjected to genotype identification. Forty-six of these samples had detectable genotypes by LIPA analysis and most (78%, 36/46) had multiple low risk (LR) and high risk (HR) genotypes on the cervix. Twenty-five of these samples (54%) had more than 1 HR genotype. Of the 36 patients who had any HR genotypes, 18 (50%) were identified to have the most oncogenic HPV genotypes, namely 16 and 18. Three of these samples had both 16 and 18 on the cervix. The presence of multiple HR genotypes on the majority of cervical samples from a self-referred population of females with EGW is presented. This study is of importance since persistent HR-HPV is the necessary risk factor in the development of precancerous and cancerous lesions of the cervix. Gardisil, the quadrivalent HPV vaccine would have been useful in the prevention of 28% (13/46) of these infections.
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Initial results from the newborn hearing screening programme in Ireland.INTRODUCTION: Hearing screening programmes aim to detect hearing loss in the neonate. The Health Service Executive (HSE) South was the first phase of a national roll-out of a neonatal hearing screening programme in Ireland, going live on 28 April 2011. RESULTS: Over 11,738 babies have been screened for permanent childhood hearing impairment (PCHI) during the first 12 months. The percentage of eligible babies offered hearing screening was 99.2 %. Only 0.2 % (n = 25) of those offered screening declined. 493 (4 %) were referred for immediate diagnostic audiological assessment. The average time between screen and diagnostic audiology appointment was 2 weeks. 15 (1.3/1,000) babies have been identified with a PCHI over the 12-month period. 946 (4 %) babies screened were admitted to the neonatal intensive care unit (NICU) for >48 h. The prevalance of PCHI is 7.3/1,000 in the NICU population compared to 0.6/1000 in the well baby population. 214 (1.8 % of total babies screened) had a clear response in the screening programmes, but were deemed to be at risk of an acquired childhood hearing impairment. These babies will be reassessed with a diagnostic audiology appointment at 8-9 months of age. To date, there is one case of acquired hearing impairment through this targeted follow-up screen. Of the 15 cases of PCHI identified, 8 (53 %) of these had one or more risk factors for hearing loss and 7 (37 %) were admitted to the NICU for >48 h. Four babies were referred for assessment at the National Cochlear Implant Centre.
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Second toe swelling: Nora's lesion or glomus tumour, case report and literature review.We report a rare case of bizarre parosteal osteochondromatous proliferation (BPOP, Nora's lesion) of the right second toe in a 60-year-old man who presented with painful, bluish and bulbous swelling of the right second toe without any break in the skin.
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The impact of HSV for inflammatory arthropathy patients.Herpes simplex virus type 1 (HSV-1), also known as herpes labialis, is the etiologic agent of vesicular lesions of the oral mucosa commonly referred to as "cold sores". HSV-1 can also cause clinical disease in a wide variety of other anatomic locations including the genitalia, liver, lung, eye, and central nervous system. These infections can be severe, particularly in the setting of immunosuppression, such as inflammatory arthropathy patients on Methotrexate ± biological therapies. Here, we highlight the importance of physician awareness of HSV due to its potential impact for rheumatology patients.
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A history of haemovigilance South Infirmary Victoria University Hospital 2000 - PresentThe Haemovigilance speciality defines itself as nursing and subscribes to the overall purpose, functions and ethical standards of nursing. The clinical practice role may be divided into direct and indirect care. Direct care comprises the assessment, planning, delivery and evaluation of care to patients. Indirect care relates to activities that influence others in their provision of direct care. The Haemovigilance Officer as a clinical professional in the Irish healthcare environment is required to maintain professional competency and this is achieved through continuous ongoing education and training, attending in-service study days, conferences locally and nationally. While attending various conferences numerous posters have been presented which have showcased the hospital’s work. Evidence of continuous professional development is contained in Appendix 1. Mission Statement: In collaboration with nursing staff, medical staff and the Irish Blood Transfusion Service, the Haemovigilance Officer strives to deliver an effective, efficient, cost effective and quality transfusion service for the patients of the SIVUH through ongoing education, surveillance and clinical audit. (Reviewed August 2011). Haemovigilance is internationally recognised as essential to the development of safe clinical transfusion practice. As the time of writing this report, the hospital in the context of the Reconfiguration of Health services for the Cork and Kerry region, is in a transitional phase as the hospital moves from an acute general hospital to an elective and largely surgical hospital. Such changes in the nature and type of clinical service provision will naturally impact on the requirement for blood and blood products.
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Eccrine porocarcinoma arising within an area of Bowen disease.Summary Very little is known about the aetiology of eccrine porocarcinoma (EP), a rare malignant sweat-gland tumour. Most reported cases have arisen de novo, or from a benign eccrine poroma. We report an unusual case, in which eccrine porocarcinoma arose at the exact site of pre-existing Bowen disease (BD).
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Preoperative information needs of children undergoing tonsillectomy.AIMS AND OBJECTIVES: To identify the information needs of children undergoing tonsillectomy with reference to content of information, method of delivery, information providers and timing of information provision. BACKGROUND: Tonsillectomy can be anxiety provoking for children and preoperative preparation programmes are long recognised to reduce anxiety. However, few have been designed from the perspectives of children and to date little is known about how best to prepare children in terms of what to tell them, how to convey information to them, who can best provide information and what is the best timing for information provision. DESIGN: A qualitative descriptive study. METHOD: Data were collected from nine children (aged 6-9) using interviews supported by a write and draw technique. Data were coded and categorised into themes reflecting content, method, providers and timing of information. RESULTS: Children openly communicated their information needs especially on what to tell them to expect when facing a tonsillectomy. Their principal concerns were about operation procedures, experiencing 'soreness' and discomfort postoperatively and parental presence. Mothers were viewed as best situated to provide them with information. Children were uncertain about what method of information and timing would be most helpful to them. CONCLUSION: Preoperative educational interventions need to take account of children's information needs so that they are prepared for surgery in ways that are meaningful and relevant to them. Future research is needed in this area. RELEVANCE TO CLINICAL PRACTICE: Practical steps towards informing children about having a tonsillectomy include asking them what they need to know and addressing their queries accordingly. Child-centred information leaflets using a question and answer format could also be helpful to children.
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The prevalence of vitamin D deficiency in consecutive new patients seen over a 6-month period in general rheumatology clinics.The objectives of this study are to assess: (a) the prevalence of vitamin D deficiency among new patients attending rheumatology outpatient departments, (b) the age profile of these low vitamin D patients and (c) whether any diagnostic category had a particularly high number of vitamin D-deficient patients. All new patients seen consecutively in general rheumatology clinics between January to June 2007 inclusive were eligible to partake in this study, and 231 out of 264 consented to do so. Parathyroid hormone, 25-hydroxyvitamin D, creatinine, calcium, phosphate, albumin and alkaline phosphatase levels were measured. We defined vitamin D deficiency as /=65 and 78% of patients aged